Lower back pain: causes, treatment, and prevention of lower back injuries and pain - Dr Stuart McGill

Dr Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favourite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

00:00:00 Dr. Stuart McGill
00:02:33 Sponsors: Helix Sleep, BetterHelp & Waking Up
00:06:23 What Causes Back Pain?; Genetics, Dog Breed Analogy
00:12:55 Tool: Skeleton & Body Type; Spine Flexibility & Discs
00:20:25 Flexibility & Exercises; Discs & Collagen
00:25:43 Sponsor: AG1
00:27:32 Stress & Tipping Point; Athletic Tradeoffs, Triathletes
00:36:17 Back Pain, Goals & Training Program
00:45:57 Spine Hygiene, Back Pain, Powerlifting
00:53:33 Genetics & Running
00:59:34 Sponsor: LMNT
01:00:46 Rehabilitation & Reducing Volume; Injury
01:07:42 Tool: Training for Lifelong Fitness, Injury & Joints
01:17:40 Pain Types, Biopsychosocial Model of Pain
01:26:15 Coaching, Explosivity & Endurance
01:32:43 Virtual Surgery & Rest, Pain Recovery
01:41:25 Tool: McGill’s Big 3; Building Back Strength & Stability
01:46:39 Inversion Tables & Spine Deloading, Disc Bulge, Tool: Lumbar Support
01:51:09 Tool: Daily Walking; Sitting
01:55:33 Deadlift & Bone Density, Glute-Ham Raise
02:06:20 Training & Age, Osteoporosis, Tool: Deadlift Alternatives
02:16:47 Tools: Biblical Training Week; Spine Stability & McGill’s Big 3; Shrinking & Age
02:24:16 Platelet-Rich Plasma (PRP); Disc Damage
02:27:56 Tools: Biblical Training Week & Strength Exercises, Neck Strength
02:35:24 Tools: Sword Play, Distal Limb Loading, Training for Symmetry
02:42:38 Tools: Biblical Training Week, Mobility & Cardiovascular Exercises, Athletic Panel
02:49:22 Zero-Cost Support, YouTube, Spotify & Apple Follow & Reviews, YouTube Feedback, Protocols Book, Social Media, Neural Network Newsletter

0:00:00 Intro
0:00:30 Peter’s experience with debilitating back pain
0:14:11 Anatomy of the back: spine, discs, facet joints, and common pain points
0:24:48 Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more
0:31:30 Why the majority of back injuries happen around the L4, L5, and S1 joints
0:37:20 How the spine responds to forces like bending and loading, and how it adapts do different athletic activities
0:45:12 The pathology of bulging discs
0:48:33 The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more
0:59:36 The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types
1:12:46 The significance of strength and stability in preventing injuries and preserving longevity
1:25:33 Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns
1:37:08 Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain
1:46:59 Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro
1:56:08 When surgical interventions may be appropriate, and “virtual surgery” as an alternative
2:05:48 Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more
2:11:21 Tarlov cysts: treatment and surgical considerations
2:13:34 The evolution of patient assessments and the limitations of MRI
2:18:40 Pain relief related to stiffness and muscle bulk through training
2:26:49 Advice for the young person on how to keep a healthy spine
2:39:24 Resources for individuals dealing with lower back pain

Dr Stuart McGill's book: Back Mechanic by Dr Stuart McGill

In an age where a seemingly endless amount of gimmicky back products are in circulation, a definitive guide to self-assessment and rehabilitation is more essential than ever. Back Mechanic guides you through a self-assessment of your pain triggers, then shows you how to avoid these roadblocks to recovery. Then effective exercises are coached in a step by step progressive plan. Spine expert, Dr Stuart McGill used his 30 years of research findings and clinical investigations to create this evidence-based guide that has helped thousands reclaim their lives. This knowledge is now available to you in this richly illustrated book. You will become your own best Back Mechanic and advocate.

Human evolutionary biology and how our modern environment is causing modern diseases - The Diary of a CEO with Dr Daniel Lieberman

Understanding Mismatch Diseases and Human Evolution

• Most people in the Western world are likely to die from a mismatch disease, which are conditions for which human bodies did not evolve. These are caused by novel environmental conditions to which humans are inadequately or imperfectly adapted. Examples include obesity, heart disease, many cancers, allergies, autoimmune diseases, and chronic stress.
• Daniel Lieberman, a Professor of Human Evolutionary Biology at Harvard University, studies the human body's evolution, particularly in physical activity and diet, to understand these modern health crises. He emphasizes that understanding our evolutionary history is crucial because humans evolved, they were not designed or engineered.
• While human ancestors were hunter-gatherers for millions of years, the idea that their lifestyle provides all the answers for modern health is a "Paleo fantasy". Natural selection primarily cares about reproductive success, not happiness or optimal health, so ancestral practices are not always optimal for health today.
• Humans are the ultimate omnivores, capable of eating almost anything due to a flexible digestive system and technology like cooking and food processing. There is no single "evolved" human diet. Humans began eating meat at least 2.5 million years ago, which played a significant role in evolutionary history.
• The evolution of the hunting and gathering lifestyle between three and two million years ago was transformative. This period saw the emergence of stone tools, butchering, cooperation, communication, and extractive foraging for high-quality underground foods.
• Key human adaptations include an external nose (around 2 million years ago) that acts as a humidifier, preventing lungs from drying out and recapturing moisture during activity. Additionally, humans developed an increased density of eccrine sweat glands across their bodies and lost fur, enabling efficient evaporative cooling, which was a huge advantage for hunting in hot environments.
• The increase in human brain size around 2 million years ago is linked to the hunting and gathering system, which made more energy available through processed foods, cooperation, and new food sources like meat and marrow. Brains are metabolically expensive, consuming a significant portion of the body's energy.
• Humans are born unusually fat (infants are about 15% body fat), which is a fundamental adaptation. This body fat acts as an energy reserve, crucial for supporting large, energy-demanding brains (especially in infants) and for financing the high energy costs of reproduction (pregnancy and nursing). Our predisposition to store fat is fundamental to the species.

How to study for exams - Evidence-based revision tips - Ali Abdaal

Ineffective Popular Revision Techniques

• Rereading
• Highlighting and Underlining
• Summarising and Note-making

Active Recall: The Most Effective Study Technique

• What it is: Active recall, also known as active retrieval or practice testing, involves the deliberate effort to retrieve facts and information from your brain.
• How it works: The very act of retrieving information actively strengthens the neural connections in the brain, which is a counterintuitive but highly effective learning mechanism.
• High Utility: Professor Dunlosky's review paper rated practice testing as having "high utility", noting it is not time-intensive, requires minimal training, and has proven efficacy in educational contexts. They recommend that everyone should engage in more self-testing.
• Intuition vs. Evidence: A 2011 study also revealed that students incorrectly rated repeated study as the most effective technique and active recall as the least effective, highlighting a significant disconnect between student perception and actual effectiveness.

How to Prevent & Treat Colds & Flu - Dr Andrew Huberman

Understanding Colds and Flu

• The Common Cold: No Cure
  There is currently no cure for the common cold because it is caused by over 160 different serotypes (types) of rhinovirus. Due to the varied shapes of these viruses, antibodies developed against one serotype are often ineffective against another, meaning individuals can catch multiple colds within a year or even a season.
• Cold Transmission and Survival
  Colds are primarily spread by breathing, sneezing, coughing, or by people touching surfaces after contact with respiratory droplets, then touching their own eyes, nose, or mouth. The cold virus is quite stable and can survive on surfaces (non-human or human) for up to 24 hours.
• Flu Virus Types and Survival
  The flu (influenza) virus also has different serotypes and general categories (A, B, C), distinguished by surface proteins (e.g., H1N1, which caused the Spanish Flu). Unlike the cold virus, the flu virus can only exist on surfaces for about 2 hours, making human-to-human contact its most typical mode of transmission.
• Flu Vaccines
  Flu vaccines exist because there are a limited number of predominant flu virus types in a given year, allowing specific vaccines to be generated. These shots can reduce the risk of contracting the targeted flu strain by about 40-60% and can also lessen symptom severity. The decision to get a flu shot is personal, based on individual risk factors and exposure levels.
• Contagion Periods
  For both colds and flu, individuals can be contagious about 24 hours before symptoms appear. They are most contagious when feeling at their worst (peak symptoms like coughing, sneezing, fever). However, the myth that one is no longer contagious after a few days or once they start feeling better, despite still exhibiting symptoms, is incorrect; continued symptoms mean continued contagion.
• Symptoms and Onset
  Cold symptoms typically develop one to two days after exposure. The severity of both cold and flu can vary from mild to very severe, and they can exacerbate other health issues.

Active versus Passive Learning - Morgan Housel

Defining Active vs. Passive Learning

• Active Learning: This is a structured approach where someone else dictates what you learn, how you learn it, and on a set schedule. It involves pre-selected, standardized topics, much like traditional schooling.
• Passive Learning: This is an unstructured and serendipitous process. It involves letting your mind wander without a specific destination, reading broadly across various subjects, engaging in conversations with people from different backgrounds, and stumbling upon topics that spark your curiosity, often because they are relevant to your life at that particular moment.

The Power and Importance of Passive Learning

The central theme of the podcast is that much of life's most valuable knowledge is acquired through passive learning.

• Personal and Enjoyable: Learning becomes more meaningful and enjoyable when it's driven by personal curiosity and pursued on your own terms. The podcast draws a parallel to writing: writing for yourself is fun and it shows, while writing for others can feel like a chore.
• Fosters True Curiosity: Passive learning allows you to discover what genuinely interests you. This is crucial because when people are forced into active learning that doesn't suit their personality, they may wrongly conclude that they dislike learning altogether.
• Sparks Connections and Insights: By exploring a wide variety of topics, you can discover surprising connections between different fields. For example, you can learn about competitive advantages in business by studying biology.

Why You Can’t Stop Eating Ultra-Processed Foods - Dr Rangan Chatterjee with Dr Chris Van Tulleken

The Danger of Ultra-Processed Foods

• Ultra-processed foods (UPFs) are a leading cause of early death and disease: UPFs are widely consumed, making up most of what we eat, and are strongly linked to numerous negative health outcomes including cardiovascular disease, metabolic disease, early death, various cancers, dementia, anxiety, depression, and inflammatory bowel disease. They are now considered a leading cause of early death globally, potentially surpassing tobacco in some areas, and are a major contributor to diet-related diseases.
• Harm extends beyond weight gain: The detrimental effects of UPF consumption are not solely tied to weight. Even individuals at a "healthy weight" who consume an average of 60% of their calories from UPFs are vulnerable to all associated harms. Many studies adjust for weight gain, proving that these negative health outcomes exist irrespective of an individual's body weight.
• UPFs are proven to cause, not just associate with, disease: Extensive research, including over 2,000 peer-reviewed publications and 70 prospective clinical studies (the same type used to prove tobacco causes lung cancer), demonstrates a causal link between UPF consumption and various health problems. There's a clear dose-dependent relationship, meaning the more UPFs consumed, the worse the effects.
• Willpower is not the primary issue: The widespread increase in weight across all demographics since the mid-1970s is primarily attributed to changes in the food environment, not a lack of willpower. For many, UPFs are the only affordable and available food options, making individual "choice" incredibly challenging. Blaming individuals for their struggles in a toxic food landscape is unjust, as powerful corporations and marketing budgets are at play.